Western EU Research Articles

Is the trend of increasing use of patient-reported outcome measures in medical device studies the sign of shift towards value-based purchasing in Europe?

BackgroundThe recent update of the European Union’s (EU) regulation on public procurement has created new opportunity for progress in the purchasing of medical devices by shifting towards focus on value from one purely on price. Patient-reported outcome measures (PROMs) may serve as additional tools for manufacturers to demonstrate value beyond traditional metrics of safety and performance and to differentiate their products in a market of increasing competition. The aim of our study was to investigate the extent to which PROMs are included in registered device studies in the EU and interpret the results in the context of the purchasing of medical devices.MethodsTwelve device groups were searched in clinical trial registries to determine the frequency distribution of PROMs in related studies.ResultsResults indicate that clinical studies of the selected device categories are done predominately in the western EU nations and are increasingly including PROMs. In the United Kingdom 121 (65%) study, out of 186 included PROMs, and in Germany, 92 (52%) out of 178 between 1998 and 2018. Few device studies were done in the Central and Eastern European region, and out of 76 studies 27 (35%) included PROMs. Since there is no requirement to include PROMs in device studies for regulatory purposes, it seems probable that their increasing use is driven by competitive market pressures.ConclusionThe trend of increasing use of PROMs might be driven by the demand of purchasers to demonstrate value of devices, but is manifested at different levels in various regions of the EU.

A meta-analysis of shrinking cities in Europe and Japan. Towards an integrative research agenda

ABSTRACT Empirical research on urban shrinkage is being conducted around the globe, since many countries are confronted with the phenomenon of shrinking cities. So far, the research on urban shrinkage has focused strongly on case studies, which is why we can benefit from a diverse and empirically rich knowledge base on the phenomenon and its regional manifestations. By bridging and comparing the European and Japanese academic discourse, we aim to identify the different recurring theories and key issues discussed under the umbrella term ‘urban shrinkage’ and strive to uncover blind spots of the debate. For this purpose, we conduct a qualitative meta-analysis of 100 empirical cases that are documented in the literature dealing with shrinking cities in the EU and Japan. This meta-analysis is based on comparative qualitative content analysis. It reveals a regionally differentiated pattern of various causes, effects and responses documented for shrinking cities in Western, Mediterranean and post-socialist EU countries and in Japan. Based on these findings, we offer an agenda for future research by suggesting an integrative perspective on the context-specific dynamics of urban shrinkage. We argue for an integrative understanding of shrinking cities in order to develop a valid knowledge base for evidence-based policy recommendations.

«The Three Seas Initiative»: Perspectives of Energy Sector Development within the Croatian Foreign Policy

The article revolves around the Three Seas Initiative, a project launched in 2015 by the Republic of Croatia and the Republic of Poland, aimed at the development of cooperation and international relations between its 12 member states in the sphere of energy, digitalization and transport. Special emphasis is put on the development of Croatia’s foreign policy in the energy sector within the aforementioned Initiative, which can be achieved through the country’s participation in the construction of an LNG terminal on the island of Krk in Croatia. Moreover, both positive and negative aspects of the Initiative are presented in the article, considering the fact it has attracted not only the attention of western EU countries, but also the United States and Russia. Croatia’s participation in the projects of the Three Seas Initiative as one of its founders is considered to be one of the biggest steps in the country’s recent foreign policy, and if successfully put into practice, the Initiative could provide Croatia an opportunity to strengthen its geopolitical position in Europe.

Framing the Shades of Sustainability in Health Care: Pitfalls and Perspectives from Western EU Countries

Sustainability is momentous for the appropriate functioning of health care systems. In fact, health and sustainability are two strictly related values, which could not be separately sought. While studies discussing the contextualization of this issue with respect to the distinguishing attributes of health care systems are rapidly blooming, there is still little agreement about what is ultimately meant by sustainability in the health care arena. On the one hand, attention is primarily focused on the proper use of available financial resources; on the other hand, people engagement and empowerment are gradually arising as a crucial step to enhance the viability of the health care system. This paper tries to identify, from a conceptual point of view inspired by the European integrative movement, the different shades of sustainability in health care and proposes a recipe to strengthen the long-term viability of health care organizations. The balanced mix of financial, economic, political, and social sustainability is compelling to increase the ability of health care organizations to create meaningful value for the population served. However, the focus on a single dimension of sustainability is thought to engender several side effects, which compromise the capability of health care organizations to guarantee health gains at the individual and collective levels. From this standpoint, further conceptual and practical developments are envisioned, paving the way for a full-fledged understanding of sustainability in the health care environment.

Non-trivial Factors as Determinants of the Environmental Taxation Revenues in 27 EU Countries

The implementation of environmental taxation is one of the most important issues of environmental policy in Europe. To approach this matter, the paper aims to analyse the determinants of environmental taxation revenue for European countries. Besides investigating the most explored determinants, such as those related to production, consumption and environmental quality, particular attention is paid to some non-trivial factors. Firstly, we analyse the importance of the institutional context that is crucial for policy enforcement. Secondly, we consider the consumption of rapidly obsolescent goods, such as information and communication technology (ICT) goods characterised by intensive waste generation. Finally, the importation of final goods as a consequence of production offshoring is taken into account. The results demonstrate that the above-mentioned determinants have a heterogeneous impact on environmental taxation revenue in EU Western countries and EU Eastern countries, which can be due to a still weak institutional context of the latter economies and their peculiar patterns of development.

COMPARISON OF WASTE MANAGEMENT SYSTEMS IN WESTERN AND TRANSITION ECONOMIES WITHIN THE WATRA PROJECT

The transition from a planned to a market economy has been a great challenge for all post-socialist states of the former Eastern Bloc. Public services which were to a major extent previously subsidized by the state needed to be adapted to new economic realities. This paper will present some of the results of a country overview report. This report represents the first working package of the WaTra project, which aims to help understand and develop the waste management systems of selected transition economies. 13 European and post-Soviet countries were chosen with different starting conditions and economic states to investigate which are the crucial factors in enabling the development of modern waste management. The countries considered were compared with each other using indicators of waste management. Waste collection, waste treatment, landfilling, recycling, composting and incinerated waste per capita are the main aspects taken into account and set in relation to economic indicators. Western EU countries generate higher amounts of waste per capita and have higher recycling rates. Landfilling is the major waste treatment method in post-Soviet and Eastern European countries, even among the EU states. The change from practices of only landfilling to modern waste management systems with high recycling and recovery is more recognizable. The more developed a country’s waste management system is, the more waste is generated according to the strengthening of its economy.

International Rivalry in The Energy Sector: The Eastern European Market of Atomic Energy in Focus

In the post-bipolar world nuclear power has become one of the areas of competition and rivalry betweenRussiaand the West. The comprehensive analysis of theoretical publications allows us to consider international competition as an abstract, depoliticized contest of states and other international actors (including companies) for some limited (mainly economic) benefits. International rivalry is more a political process, necessarily involving some rival pairs of states (or groups of states) that compete with each other not only to get some benefits, but to expand their territory or power. The competition and rivalry betweenRussiaand the West in the sphere of nuclear power are especially apparent in the Eastern European region where the American, European and Japanese corporations, with the support of the Western foreign ministries and EU institutions, try to achieve two main goals. The first goal is to win the contracts to build new power units, especially in tenders where Rosatom participates. The second goal is to become suppliers of nuclear fuel for multiple Russian- or Soviet-made VVER-type reactors, which are functioning or will be run in a number of countries in the region (Slovakia,CzechRepublic,Hungary,Bulgaria, andUkraine). Such activities can involve high risks. The West’s efforts to curb the dominant position of "Rosatom" inEastern Europeare formally associated with the need to create a "competitive market" of nuclear services in the region and to ensure the European energy security. It is also noteworthy that the expansion of Rosatom (and its predecessors) to foreign markets, including Eastern Europe, is actively supported by the Russian state which in the second half of the 1990s – after a failed attempt of following in the footsteps of the West – joined in the rivalry, mostly imposed by the U.S. and their allies. As shown by the analysis,Russiaand the West, primarily theUnited States, are involved in the nuclear power sector to advance their economic interests, expressed in the success of their national corporations. However, they are also political rivals that consider the nuclear power industry generating billions of dollars and supplying energy to many countries as one of important geopolitical resources.

Recipe for success: A network perspective of partnership in nature conservation

Successful conservation initiatives require collaboration between stakeholders across a range of organisational foci and expertise. In Romania, the EU LIFE Nature programme is the most important financing instrument for nature conservation, and projects commonly involve partnerships between public authorities, NGOs, enterprises, and research institutions. To understand strengths and gaps in conservation partnerships for LIFE Nature projects implemented in Romania, we applied a Social Network Analysis approach to 85 partner organisations across 35 projects. We complemented this approach with a questionnaire directed to project managers to identify the criteria for selecting partners, and the role of partners in the project. The network included mostly public authorities (50%), yet the Romanian Ornithological Society (NGO) and the University of Bucharest were the most influent organisations in the network. Public authorities, park authorities, and enterprises were often selected as partners because of their financial contributions and local connections. In contrast, research institutions and NGOs were selected as partners because of their technical expertise and policy influence at the national level. Furthermore, research institutions, parks authorities and NGOs were involved in proposal writing, preparatory and management activities, while public authorities had no predefined roles in LIFE projects. The analysis also showed that the Romanian conservation system is polycentric, with influence shared between research organisations, NGOs, and public authorities. Interviews with project managers revealed that Romania submits relatively fewer projects compared to Western EU countries because public agencies have low technical and logistic capacity. We recommend a national level strategy for increasing project submission rates and quality of proposals that addresses the need for strengthening ties between core organisations and public authorities, especially at the local level. These findings are likely to be applicable to other EU member states that are currently struggling to get funding for conservation projects, ultimately moving the EU closer to achieving the European Union Biodiversity Strategy 2020 targets.

Thoughts from an anti-model migrant wading through Brexit

Over some strong chai with a Turkish academic friend who teaches at a university in the Midlands, our conversation turned to our shared amusement from the reactions of largely White, Western European academics and activists since Brexit, who are demanding special rights to ensure that EU citizens can live in the United Kingdom. He recounted a story from a colleague of his, a White Western European lecturer from Luxembourg who has spoken many times to my friend ot her profound worries that she and her partner will be forced to leave the United Kingdom as a result of Brexit. My friend also has the same worries as his fellow EU academic peers when it comes to Brexit, and particularly as a person of colour, the emboldened and overt surge in racist violence against migrants of colour, especially those who are Muslim. However, unlike his White, Western European colleagues who have racial and passport privileges that prevent them from experiencing the full brutality of border controls, my friend has nowhere to go. Since the July 2016 Turkish coup, a report by Turkey Purge (2016) has found a total of 7,317 academics have been purged from teaching with an additional 4,811 academics dismissed from their positions. When my friend asked his colleague why she was not applying for citizenship, her reply was equally telling, 'I'm not British. I don't want to lose my Luxembourg citizenship. After all, it is the golden ticket'. We both reflected that had a Muslim, Black or Brown migrant student or university worker echoed the same response, this would be seen as proof by fascist, right-wing and liberal racists that these specific kinds of migrants are hostile to integrating and adopting so-called 'British values'. It would also be the very grounds used to justify the more heightened forms of racialised surveillance that we currently have in place in the United Kingdom, such as Prevent, and the strengthening of what Terese Jonsson (2017) aptly describes as 'British fundamentalism'- where 'whiteness is reinforced in the British values discourse through its erasure of structural and everyday racism faced by people of colour'. However, when a White, Western European academic makes such a response, she knows that her whiteness and class are also another 'golden ticket' that shields one from any direct questioning or awkward conversations about her geo-political and religious loyalties. The 'model migrants' we sympathise with: White, Western European and middle class As migrant-rights activism has intensified since the Brexit decision, unfortunately, a good percentage of mainstream activism has centred around protecting and advocating for special rights for EU migrants over that of safeguarding the ever-dwindling rights of all migrants, whether documented or not. Much of this particular kind of migrant rights activism is also racialised, in that the voices and concerns of largely White, middle-class EU migrants are both sympathised with and seen as uniquely deserving of fighting and advocating for in the face of Home Office restrictions. The media in turn has presented a number of stories that actively sympathise with the plight of White Western EU migrants. For instance, the Daily Mail, a publication known for its sensationalist racist and xenophobic diatribes against migrants who are Black or Muslim, recently printed a supportive piece centring around a White, middle-class Dutch-Spanish couple who after Brexit, decided to apply for citizenship for themselves and their children, who were born and raised in the United Kingdom. While the couple were granted citizenship, their children were denied citizenship on the grounds that the Home Office did not believe there was enough evidence to prove that the children lived permanently in the United Kingdom with their parents (Gordon 2017). A deep sense of suspicion that is consistently reserved for Black or Muslim migrants about the veracity of truth regarding their migration story was nowhere seen in this particular piece. …

The Unbearable Whiteness of the Polish Plumber and the Hungarian Peacock Dance around “Race”

This contribution interprets the east-central European post-liberal governments’ recent anti-immigrant, anti-refugee and anti-human-rights hysteria in the context of the increasing dependence of the region's societies for livelihood on employment in the western EU, the widespread racialization of east European labor in the western EU, and the refusal of east European political elites and societies at large to consider possible “Left” critiques of the EU. Given those circumstances, and laboring under related anxieties, post-state-socialist political elites and societies have assumed a fundamentalist-racialist posture. They redirect their repressed anger toward incoming refugees, claim an ahistorical, essential kind of Whiteness and contribute to rigidifying European discussions of “race.”

The Western Balkans and EU enlargement - lessons learned, ways forward, prospects ahead

The Western Balkans and EU enlargement - lessons learned, ways forward, prospects ahead

The modality effect on reading literacy: perspectives from students’ online reading habits, cognitive and metacognitive strategies, and web navigation skills across regions

ABSTRACTThis study tested the effects of the modality of reading formats (electronic vs. print), online reading habits (engagement in different online reading activities), use of cognitive strategies, metacognitive knowledge, and navigation skills on printed and electronic reading literacy across regions. Participants were 31,784 fifteen-year-old students (50.78% female) from 19 countries and economies in the 2009 Programme for International Student Assessment database. Results showed that students exhibited better reading literacy in the print environment. Moreover, information-seeking activities, control strategies, knowledge of metacognitive strategies, and navigation skills positively predicted reading literacy in both print and electronic formats for all regions, whereas social reading activities negatively predicted reading literacy in print and were most harmful for the Asian region in both formats. Memorization strategies were negatively associated with reading literacy in both formats for Australasian, Western and Eastern EU, and South American regions, but not for the Asian region. Online reading habits, regardless of types, had no impact on reading literacy in both formats for the South American region. The study findings provided suggestions for literacy instruction in the e-learning era across different regions.

No difference in the intention to engage others in academic transgression among medical students from neighboring countries: a cross-national study on medical students from Bosnia and Herzegovina, Croatia, and Macedonia

AimTo asses if the level of intention to engage others in academic transgressions was comparable among medical students from five schools from neighboring Southern-European countries: Croatia, Bosnia and Herzegovina, and Macedonia; and medical students from western EU studying at Split, Croatia.MethodsFive medical schools were surveyed in 2011, with ≥87% of the targeted population sampled and a response rate of ≥76%. Students’ intention to engage a family member, friend, colleague, or a stranger in academic transgression was measured using a previously validated the Intention to Engage Others in Academic Transgression (IEOAT) questionnaire and compared with their intention to ask others for a non-academic, material favor. Data on students’ motivation measured by Work Preference Inventory scale, and general data were also collected. Multiple linear regression models of the intention to engage others in a particular behavior were developed.ResultsThe most important determinants of the intention to engage others in academic transgression were psychological factors, such as intention to ask others for a material favor, or students’ motivation (median determinant’s β of 0.18, P ≤ 0.045 for all), whereas social and cultural factors associated with the country of origin were either weak (median β of 0.07, P ≤ 0.031) or not relevant. A significant proportion of students were aware of the ethical violations in academic transgressions (P ≤ 0.004 for all transgressions), but a large proportion of students also perceived academic cheating as a collective effort and were likely to engage people randomly (P ≤ 0.001 for all, but the most severe transgression). This collective effort was more pronounced for academic than non-academic behavior.ConclusionCulture differences among neighboring Southern-European countries were not an important determinant of the intention to engage others in academic cheating.

Fleeing the centre: the rise of challenger parties in the aftermath of the euro crisis

The eurozone crisis has altered the party political landscape across Europe. The most visible effect is the rise of challenger parties. The crisis not only caused economic hardship, but also placed considerable fiscal constraints upon a number of national governments. Many voters have reacted to this by turning their back on the traditional parties and opting instead for new, or reinvigorated, challenger parties that reject the mainstream consensus of austerity and European integration. This article argues that both sanctioning and selection mechanisms can help to explain this flight from the centre to challenger parties. First, voters who were economically adversely affected by the crisis punish mainstream parties both in government and in opposition by voting for challenger parties. Second, the choice of specific challenger party is shaped by preferences on three issues that directly flow from the euro crisis: EU integration, austerity and immigration. Analysing both aggregate-level and individual-level survey data from all 17 Western EU member states, this article finds strong support for both propositions and shows how the crisis has reshaped the nature of party competition in Europe.

Current situation of Crimean-Congo hemorrhagic fever in Southeastern Europe and neighboring countries: a public health risk for the European Union?

Crimean-Congo hemorrhagic fever (CCHF) is the most widespread tick-borne viral infection of humans, occurring across western China through southern Asia, Middle East, and Southeastern Europe (SEE) and in the most of African countries. CCHF virus is maintained through vertical and horizontal transmission in several genera of ticks, mainly in Hyalomma, which spreads the virus to a variety of wild and domestic mammals, which develop a transient viremia without signs of illness. Human infections occur through tick bite or exposure to the blood or other body fluids of an infected animal or of a CCHF patient. In SEE the number of clinical cases of CCHF as well as the areal of the infected ticks continuously rapidly increased after 2000. The aim of this study was to present actual situation of CCHF in SEE. Sources of information include published literature and personal unpublished data. Based on: 1. Hyaloma's presence in Western EU countries, 2. Changes in climatic conditions and 3. Absence of an active vaccination against CCHF, it can be expected that this disease will continue to present real threat for human health in SEE and Southwestern Europe (SWE).

A three-year survey of honey bee viruses in Lithuania

Six honey bee viruses, acute bee paralysis virus (ABPV), Israeli acute paralysis virus (IAPV), Kashmir bee virus (KBV), deformed wing virus (DWV), sacbrood virus (SBV), and black queen cell virus (BQCV), were studied in Lithuanian honey bees using molecular methods. Our three-year study (2012–2014) revealed an increase in virus-infected colonies from 66.2% in 2012 to 90.6% in 2014. BQCV and SBV were the most widespread viruses, with higher prevalence in summer compared to autumn. The prevalence of DWV was lower compared to other European countries, while ABPV and IAPV were not detected at all, suggesting much less spread compared to western EU countries. A single colony was infected by KBV. A decrease in single virus infections and increase in multiple infections during the three-year period was revealed. BQCV and SBV were most commonly involved in multiple infections. A phylogenetic analysis revealed that the partial polyprotein gene sequences of the viruses detected in Lithuanian honey bee colonies were closely related to those of viruses recorded in European countries, e.g., Belgium, Germany, Hungary and the UK. Two European and Asian geographically separated genotypes of both SBV and DWV in honey bee populations were also revealed.

The European Struggle to Educate and Include Roma People: A Critique of Differences in Policy and Practice in Western and Eastern EU Countries

Multiculturalism is an established feature of the UK and other European States since the establishment of the Treaty of Rome in 1959. Enlargement has brought EU membership from six (1952) to twenty eight members since its foundation, and allowed free migration across its borders. However, many countries, in spite of agreements to adhere to ‘democratic’ practices, deny minority citizens their full rights, particularly in education contexts. Some recent accession EU States have education systems that are less adaptive to expected policy responsibilities. It is a more unstable aspect of Eastern Europe because of the failure of many of these countries to reduce social and educational inequalities and to establish rights for minority groups, particularly the Roma. An educational focus is used as a platform to highlight issues re the segregation, and discrimination against, Roma children in Europe, typically through the use of special education, which is not suitable for them. Europe generally, both East and West has failed to fully integrate the Roma. Often, institutional blame is placed on Roma communities, rather than situate them socially and economically due to ingrained structural inequalities. Stereotyped categories are often used to ‘label’ them. Countries with high Roma populations, four in Western and five in Eastern Europe are evaluated and compared in relation to the education of Roma children.

Governance Convergence Among the EU28?

The paper attempts to detect trends of convergence in terms of governance among the EU member-states. This is an issue that has not hitherto been examined. The empirical analysis provided utilizes the worldwide governance indicators, employs the methodological approach of convergence clubs and covers the period 1996–2012. Findings reported herein point to clear trends of convergence. With the notable exceptions of some lead countries, the vast majority of EU member-states tend to form one convergence club in each of the six governance indicators considered. Yet, there are still appreciable differences. By and large, the northern and the western EU member-states exhibit significantly larger values compared to the southern and the eastern ones. This means that despite the convergence trends detected, notable divisions among the EU member-states still remain.

The homogeneity of two sets of European economies

It is generally accepted that an economy may be represented by a set of economic parameters. The normalised versions of these parameters are here assumed as coordinates in a Cartesian space. The homogeneity of a set of economies is then defined as the inverse of the sum of the distances of each economy from the others of the set (M. Caputo, Meccanica, 2014). The approach is applied to 2 sets of economies of the EU countries: 5 Western supposedly with evolved economies and 5 Eastern supposedly aiming to a better economic condition and using sets of 12 and 14 parameters respectively. It is found that, in the period 2000-2010, the homogeneity of both sets oscillates in time and that it does not seem that the 2 sets evolve to a common homogeneity. This is confirmed by the same type of analysis applied to the set of the 5 Western EU economies using 29 economic parameters of the year 2012 (M. Caputo, Meccanica, 2014) finding that the homogeneity of this set keeps oscillating.

Structural damage caused by the invasive crayfish Procambarus clarkii (Girard, 1852) in rice fields of the Iberian Peninsula: a study case

The red swamp crayfish (Procambarus clarkii) is considered one of the most invasive species for aquatic ecosystems. Since its introduction in Spain in 1973, it has spread over different wetlands throughout Western Eu- rope, having rapidly adapted to lakes, ponds and coastal marshes. Among the invaded ecosystems, rice-growing areas have been largely affected by crayfish habits, mainly due to their digging behaviour. In pursuit of this, we at- tempted to draw some patterns about the dynamics of the red swamp crayfish population inhabiting the Ebro Delta Natural Park (NE Spain) - one of the main rice-producing areas within the Mediterranean region - in relation to the structural damage caused to draining structures. More specifically, we aimed at establishing links between the local densities of crayfish, the abundance of burrows they use to shelter, and the intensity of damage involved by crayfish digging activity. For this purpose, two approaches relating crayfish density data with abundances of burrows, com- plemented with in-situ observations of structural damage, were designed. Preliminary results indicated that crayfish density and the number of active burrows were positively related, with higher values implying severe damage to draining structures. However, intense digging activity periods did not directly relate to crayfish density, since other factors were also involved. The information obtained could be useful in planning future surveys in which sound details on digging behaviour and, consequently, the structural damage entailed, could be profitably assessed.